In the initial hours after his double hand transplant surgery at Brigham and Women’s Hospital, Richard Mangino stared at his unfamiliar wrists and fingers and questioned the wisdom of his decision. He knew he faced months of grueling rehabilitation and lifelong risks from medications to prevent rejection.
But over the next two days, he felt twinges deep in his new appendages. And then, he said yesterday, a light went off in his head: “I have hands. I’m like everyone else.’’
Mangino, who lost his forearms and legs to a terrible bloodstream infection in 2002, received the two new hands last week during a 12-hour operation that was the second hand transplant performed at the hospital.
Forty surgeons, nurses, anesthesiologists, residents, radiologists and physician assistants attached left and right forearms and hands from an anonymous donor below Mangino’s elbows, including bones, skin, tendons, muscles, ligaments, and blood vessels.
The Brigham’s hand transplant program accepts patients up to age 60, but the hospital made an exception for Mangino, who is 65, because of his “good physical health’’ and exceptional drive, a quality that will help him during months of rehabilitation, said Dr. Simon Talbot, who led the hand transplant team.
Even as a quadruple amputee, Mangino, of Revere, became a prolific artist, holding a brush in the prosthesis he attached to his left arm. He tirelessly taught himself to do many things others take for granted, from dressing to picking up a dime from the floor.
He mastered shoveling waist-deep snow from his walkway last winter; he wears prostheses on his legs. And he exercises at home four times a week for 1 1/2 hours a day, using a treadmill, bike, and weights, a regimen that includes between 500 and 1,000 sit-ups.
The Brigham announced the surgery yesterday morning during a press conference. The room fell silent as Mangino entered in a wheelchair with his hands and forearms propped up on pillows, looking completely normal. The donor’s hands were a perfect skin and color match for Mangino. As cameras clicked, he smiled broadly.
“It’s just like you can fly,’’ he told reporters about having hands again. “It’s like a bird that got its wings back.’’
Mangino has already begun the rehabilitation, which could take up to two years and is expected to give him fully functioning hands, doctors said. He should be able to hold a fork and a comb, grow fingernails, and stroke the hair of his two young grandsons, a simple gesture he said he has prayed for since they were born.
“The brain rewires and gains control of the new part, claiming it as its own,’’ said Dr. Bohdan Pomahac, director of plastic surgery transplantation at the Brigham. He said Mangino is recovering well and has not had any complications.
Doctors were cautious about whether Mangino will be able to strum the guitar again, an activity he hopes to resume after a youth playing in bands in the 1960s at Revere Beach.
“Mr. Mangino has a lot of therapy ahead of him, but we never say never,’’ Talbot said.
Mangino said he chose to have the transplant because, despite his full life, every day as a quadruple amputee was a struggle, with many activities causing him physical pain.
Only now, he said, does he realize how much he hurt before the transplant and the “mental nightmare it was every day’’ just “taking a shower, shaving, getting coffee ready,’’ tasks he did himself because he did not want to burden his family.
It was the pain and the difficulty of doing the simplest things that helped to persuade the Brigham surgeons that the benefits of the transplant outweighed the risks for Mangino. The drugs transplant patients take to keep the immune system from attacking the donor tissue can leave patients vulnerable to infection.
“What people don’t quite appreciate is all the other functions that hands have: social, symbolic, expressive,’’ Pomahac wrote in an e-mail. “You can’t shake a hand with a prosthesis, and it is extremely hard to put both arm prostheses on.’’
A single hand transplant “is perhaps ethically a closer call,’’ he added, but a “double is really not.’’
In May, the plastic surgery team transplanted an entirely new face and two hands to Charla Nash, a Connecticut woman who was attacked by a chimpanzee. The face transplant was successful, but the hand transplant failed when Nash experienced an unusual cascade of complications that began with pneumonia after surgery.
She developed sepsis, a bloodstream infection, and her blood pressure dropped so low that her new hands were starved of blood, similar to what happened to Mangino a decade ago when he lost his own lower arms and lower legs.
Pomahac said that worldwide, more than 50 hands have been transplanted onto about 30 patients; some were double hand transplants. About a dozen of those hands have been transplanted in the United States, he said.
Generally, results have been good, with 98 percent of patients gaining sensation in their new hands. Aside from Nash, a couple of other patients have lost transplanted hands due to various complications.
Before he got sick, Mangino was in charge of the ground crew for United Airlines at Logan International Airport. He said he had a kidney stone in March 2002, which developed into sepsis. He almost died, but doctors at Massachusetts General Hospital used powerful medications to put Mangino into a coma to help him heal. The infection ravaged his body, however, depriving his limbs of blood.
He remained in the hospital for two months as doctors tried to save his limbs, but their attempts failed and in July 2002, surgeons amputated his legs about 8 inches below his knees, and his arms about 6 inches below his elbows.
During an interview in August, Mangino’s eyes welled up with tears when he talked about that time. Suicide briefly crossed his mind when he woke from the coma, because he did not want to burden his family, but he quickly regained his zest for life.
When his prosthetic legs were being fabricated, Mangino was asked how tall he had been. Five-foot-10, he replied, inflating his height by three inches.
“I already lost a lot,’’ he said during the August interview, flashing an impish grin. “And everybody wants to be taller.’’
In the past year, Mangino has undergone a battery of psychological and physical tests in preparation for the surgery. He said yesterday that he was scared and had reservations about whether he was strong enough to pull through the operation.
The new hands look “amazing,’’ his wife, Carole, said in an interview yesterday. “It looks like he never lost them.’’
She said she is apprehensive about him returning home in a week or two, when more of his daily medical care will fall to him and his family; they have three adult sons. He will return to the hospital five days a week, at least initially, for rehabilitation.
After the press conference yesterday, Mangino’s grandsons - Trevor, 5, and Nicholas, 3 - bounded into a conference room and saw him for the first time since the surgery.
“Hi, grandpa!’’ they said, and kissed him. Only after being asked, did Trevor say he noticed anything different.
“His hands!’’ he replied.Kay Lazar can be reached at firstname.lastname@example.org. Liz Kowalczyk can be reached at email@example.com.
Correction: Because of a photographer’s error, a caption with a Page One story yesterday about a double hand transplant used the wrong first name of the patient’s wife, Carole Mangino.